{{ Form::label('first_name', __('messages.user.first_name').':', ['class' => 'form-label']) }} {{ Form::text('first_name', null, ['class' => 'form-control', 'required', 'tabindex' => '1','placeholder'=>__('messages.user.first_name')]) }}

{{ Form::label('last_name', __('messages.user.last_name').':', ['class' => 'form-label']) }} {{ Form::text('last_name', null, ['class' => 'form-control', 'required', 'tabindex' => '2','placeholder'=>__('messages.user.last_name')]) }}

{{ Form::label('email', __('messages.user.email').':', ['class' => 'form-label']) }} {{ Form::email('email', null, ['class' => 'form-control', 'required', 'tabindex' => '3','id'=>'pharmacistEmail','placeholder'=>__('messages.user.email')]) }}

{{ Form::label('designation', __('messages.user.designation').':', ['class' => 'form-label']) }} {{ Form::text('designation', null, ['class' => 'form-control', 'tabindex' => '4','placeholder'=>__('messages.user.designation')]) }}

{{ Form::label('phone', __('messages.user.phone').':', ['class' => 'form-label']) }}
{{ Form::tel('phone', getCountryCode(), ['class' => 'form-control phoneNumber', 'id' => 'pharmacistPhoneNumber', 'required', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")', 'tabindex' => '5']) }} {{ Form::hidden('prefix_code',null,['class'=>'prefix_code']) }}

{{ Form::label('qualification', __('messages.user.qualification').':', ['class' => 'form-label']) }} {{ Form::text('qualification', null, ['class' => 'form-control', 'tabindex' => '8','placeholder'=>__('messages.user.qualification')]) }}

{{ Form::label('dob', __('messages.user.dob').':', ['class' => 'form-label']) }} {{ Form::text('dob', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light pharmacistBirthDate form-control' : 'bg-white pharmacistBirthDate form-control'), 'id' => 'pharmacistBirthDate', 'autocomplete' => 'off', 'tabindex' => '9','placeholder'=>__('messages.user.dob')]) }}

{{ Form::label('blood_group', __('messages.user.blood_group').':', ['class' => 'form-label']) }} {{ Form::select('blood_group', $bloodGroup, null, ['class' => 'form-select pharmacistBloodGroup', 'id' => 'pharmacistBloodGroup', 'placeholder' => __('messages.user.select_blood_group'), 'data-control' => 'select2', 'tabindex' => "10"]) }}

{{ Form::label('password', __('messages.user.password').':', ['class' => 'form-label']) }} {{ Form::password('password', ['class' => 'form-control','required','min' => '6','max' => '10', 'tabindex' => '11','placeholder'=>__('messages.user.password')]) }}

{{ Form::label('password_confirmation', __('messages.user.password_confirmation').':', ['class' => 'form-label']) }} {{ Form::password('password_confirmation', ['class' => 'form-control','required','min' => '6','max' => '10', 'tabindex' => '12','placeholder'=>__('messages.user.password_confirmation')]) }}

{{ Form::label('gender', __('messages.user.gender').':', ['class' => 'form-label']) }}
{{ __('messages.user.male') }} {{ Form::radio('gender', '0', true, ['class' => 'form-check-input', 'tabindex' => '6','id'=>'pharmacistGenderMale']) }} {{ __('messages.user.female') }} {{ Form::radio('gender', '1', false, ['class' => 'form-check-input', 'tabindex' => '7','id'=>'pharmacistGenderFemale']) }}

{{ Form::label('status', __('messages.common.status').':', ['class' => 'form-label']) }}

{{ Form::label('image',__('messages.common.profile').(':'), ['class' => 'form-label']) }}

{{ Form::label('address1', __('messages.user.address1').':', ['class' => 'form-label']) }} {{ Form::text('address1', null, ['class' => 'form-control','placeholder'=>__('messages.user.address1')]) }}

{{ Form::label('address2', __('messages.user.address2').':', ['class' => 'form-label']) }} {{ Form::text('address2', null, ['class' => 'form-control','placeholder'=>__('messages.user.address2')]) }}

{{ Form::label('city', __('messages.user.city').':', ['class' => 'form-label']) }} {{ Form::text('city', null, ['class' => 'form-control','placeholder'=>__('messages.user.city')]) }}

{{ Form::label('zip', __('messages.user.zip').':', ['class' => 'form-label']) }} {{ Form::text('zip', null, ['class' => 'form-control', 'maxlength' => '6','minlength' => '6','placeholder'=>__('messages.user.zip')]) }}

{{ Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-2']) }} {!! __('messages.common.cancel') !!}

{{ __('messages.user.address_details') }}